Wednesday, March 8, 2006

Different tests for different folks

Clinical trials subject of annual breast cancer symposium

Dr. Marc Lippman addresses the audience at EI's Open Forum. Express photo by Dana DuGan

Dr. Marc Lippman is one of the world's leading authorities in the field of breast cancer. As scientific advisor of the Expedition Inspiration board, he told the audience at the organization's Open Forum March 2 that the Laura Evans Memorial Breast Cancer Symposium is an important place to "harangue, challenge and talk over the issues with fellow researchers. It really has a rejuvenating and refining aspect."

Clinical trials were the subject of the symposium this year in Sun Valley.

"Each gene is like a volume in the library that is our body," said Dr. Stephen Weiss of the University of Michigan. "There are 30,000 volumes to that library. They can make anything, eyes, ears, cancer. What part of these 30,000 volumes produces those cancer cells and how does it call on blood vessels to bring it food?"

Lippman who always brings a sense of humor and clarity to the sometimes-dry proceedings discussed his own work.

"While it's true there are 30,000 books in the library and they've got lots of writing in them, there are people who hope somehow one might be more important than the others regarding certain regulatory components of the system. Not every component is equally weighted," he said.

"Whatever else is true, estrogen needs to play a critical part in breast cancer. At puberty every woman should develop breasts. For the next 20, 30, 40 years your body is bathed in estrogen, but your breasts don't continue to grow. You don't become a breast. The signal is there to grow and there's a signal that says enough is enough.

"We've been using a variety approaches and have uncovered a gene called Rev-1, which in my mind is one of the most important books in the library. We know that if we interfere with the functioning of this gene we can completely interrupt the growth and stimulation of estrogen in breast cancer. We can stop it cold in the models we used. That has given us a lot of excitement. This gene is not widely expressed in other tissues and that's a good thing."

Fellow featured speaker Dr. Lajos Pusztai, with the MD Anderson Cancer Center at University of Texas, develops genetic and molecular testing.

"We believe genetic testing projects what kind of treatment the patient gets," he said.

Dr. Julie Gralow, director of the Women's Cancer Genetics & Risk Reduction Clinic at the University of Washington, reported that her newest clinical trial deals with the occurrence of bone mestatises. Bones are often the site of "distant spread," meaning away from the breast. She is looking into a class of drugs used to prevent osteoporosis called bisphosphinates.

"Someday there will be appropriate testing for a variety of genes," Gralow said. "What I'm most excited about is finding out who doesn't need chemotherapy. We give way too much chemo to early-stage breast cancer patients."

One of the two pathologists present, Dr. Soonmyung Paik of the National Surgical Adjuvant Breast and Bowel Project, and a cancer survivor himself, said after his own bout he became interested in why cancer research was still so slow. Trials can take years to complete and even more years for a drug to be developed and approved.

Dr. Chris Benz is also impatient. "I'd like to make an impact before my career is over. It took 20 years to discover theoncogene," a modified gene that increases the malignancy of a tumor cell.

"We're trying to collapse that time. We don't want 20 more years to go by to discover a way to treat it. We need to improve on these successes and understand the aging process. Aging is the number one risk factor in cancer, but we don't know why. "

Dr. Angela DeMichele of the University of Pennsylvania sounded slightly more positive.

"We actually are going further. There are now non-invasive ways of seeing what's happening to the tumor while we're treating it. We ask patients to go through biopsies, trials and testing. There's a desire from patients and the lay public to go forward; even though they may not benefit, others down the line will."

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